Very common (nearly one in two subjects is reached at one time or another of his life), the dandruff states of the scalp are chronic conditions evolving by outbreaks interspersed with periods of remissions; they mainly concern men from 18 to 40 years old. But if the presence of dandruff, hyperseborrhoea and pruritus may reflect a minor dandruff condition, it is sometimes the sign of a serious pathology requiring a precise differential diagnosis.
A. Clinical aspect and diagnosis
The most common and benign form, the simple pityriasis is characterized by non-adherent dander and the absence of erythema and pruritus. It can progress to inflammatory stages with thicker scales adhering to the scalp; various clinical forms of progression to more severe seborrheic states are described: pityriasis gras (moderate seborrheic dermatitis with large, adherent, thick scales, diffuse erythema, pruritus with sometimes scratching lesions), asbestosis pityriasis (very thick scales) until the hair, inflammatory and oozing skin) and the steatoid pityriasis (very seborrheic form aggravated by the lack of hygiene).
The etiopathogeny of seborrheic dermatitis, still controversial, seems to be related to hyperseborrhea and the development of a cutaneous saprophyte yeast, Malassezia furfur. The diagnosis will be made after eliminating the other pathologies associated with seborrheic and squamous states of the scalp: psoriasis, contact eczema, atopic dermatitis, ringworm, chronic lupus erythematosus, lichen planus, icthyoses.
It should be noted that simple pityrias is rare in children; any scaly scalp lesion should be reminiscent of a poorly or not alopecific ringworm, psoriasis, a false dwarf moth, etc.
B. Conduct of treatment
Local treatments can relieve episodes but do not prevent recurrence, hence the importance of maintenance treatments. The treatment is based on the elimination of scales with a specific shampoo and on the application of antifungal, anti-inflammatory and antipruritic care.
There are many shampoos and dandruff lotions, which we have presented for a better understanding, the various active ingredients. This list is not exhaustive; there are other effective lotions and shampoos. The choice will be guided by the appearance and cause of the dandruff condition.